Provider Demographics
NPI:1083683460
Name:CAVAZOS, DANIEL RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RAYMOND
Last Name:CAVAZOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:730 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4562
Mailing Address - Country:US
Mailing Address - Phone:757-873-1554
Mailing Address - Fax:757-873-3239
Practice Address - Street 1:730 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4562
Practice Address - Country:US
Practice Address - Phone:757-873-1554
Practice Address - Fax:757-873-3239
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101057027207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0900803OtherUNITED HEALTHCARE
VA11544OtherSENTARA HEALTH PLANS
VA213284OtherCIGNA
VA541869550OtherVIRGINIA HEALTH NETWORK
VA54-1869550OtherTRICARE/CHAMPUS
VA64-0607-6Medicaid
VA243101OtherBLUE CROSS BLUE SHIELD OF VIRGINIA
VA25668411OtherMAMSI
VA425405OtherSOUTHERN HEALTH SERVICES
VA541869550OtherPHCS
VA5982583OtherAETNA
VA54-1869550OtherTRICARE/CHAMPUS
VA54-1869550OtherTRICARE/CHAMPUS
VA3899680001Medicare NSC